1. Enhanced Recovery After Cardiac Surgery: A Propensity-Matched Analysis
- Author
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Spencer Kiehm, Sary F. Aranki, Maria Bentain-Melanson, Siobhan McGurk, Kareem Bedeir, Martin Zammert, Tsuyoshi Kaneko, Jennifer Choi, Isidore Dinga Madou, Karen Morth, James D. Rawn, Morgan Harloff, Dirk Varelmann, Edward Percy, Daniel Rinewalt, Hari R. Mallidi, Douglas C. Shook, Sameer A. Hirji, Farhang Yazdchi, Ashraf A. Sabe, Prem Shekar, Jeffrey Swanson, and Sharon Woo
- Subjects
Pulmonary and Respiratory Medicine ,Nothing by mouth ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Patient satisfaction ,Aortic valve replacement ,law ,medicine ,Humans ,Cardiac Surgical Procedures ,Stroke ,Retrospective Studies ,business.industry ,Atrial fibrillation ,General Medicine ,Length of Stay ,medicine.disease ,Intensive care unit ,Cardiac surgery ,Treatment Outcome ,030228 respiratory system ,Anesthesia ,Propensity score matching ,Surgery ,Enhanced Recovery After Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Enhanced Recovery After Surgery (ERAS) pathways have improved clinical outcomes, cost-effectiveness, and patient satisfaction across multiple non-cardiac surgical specialties. Since the adaptation of ERAS in cardiac surgery is rapidly increasing yet still evolving, herein, we demonstrate early results of our implementation of ERAS cardiac guidelines. We retrospectively reviewed all patients who were managed with our institutional ERAS Cardiac Surgery guidelines between 5/2018 and 6/2019(N = 102). Postoperative primary outcomes (total ventilation times(hours), intensive-care unit(ICU) stay, and postoperative hospital length of stay (LOS)) were compared to 1:1 propensity matched controls from the pre ERAS era between January 2017 and March 2019. A total of 76 propensity-matched pairs were identified. Compared to the matched controls, ERAS patients had significantly shorter median ventilation times(3.5 vs. 5.3 hours, p = .01), ICU stays(median 28 vs 48 hours, p=.005) and postoperative hospital LOS (median 5 vs. 6 days, p = .03). There were no operative mortalities and no significant differences in 30-day readmission rates. There were also no significant differences in post-operative stroke, acute kidney injury, atrial fibrillation, and reoperation rates for bleeding. Two-year survival was also not statistically different between the two cohorts (p = .22). Our initial experience with implementation of ERAS protocols in cardiac surgery appear to demonstrate that these protocols are associated with shorter ventilation times, ICU stay, and hospital LOS without compromising patient outcomes. While these results are promising yet preliminary, further studies are warranted to demonstrate whether ERAS algorithms in cardiac surgery can consistently expedite postoperative recovery and improve outcomes.
- Published
- 2022